Highlighting the impactfulness of tobacco regulations and the success of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), an April 2017 report by peer-reviewed medical journal The Lancet has found that tobacco usage has dropped in most countries in the past two decades.

The Lancet report used estimates of daily smoking prevalence differentiated by sex, age group, and year for 195 countries and territories between the years 1990 and 2015.

The report found that the global prevalence of men who smoke daily fell from 35% in 1990 to 25% in 2015; the prevalence among women dropped from 8.2% to 5.4%.

The degree of this drop, however, is heterogenous across countries and the pace of progress is varied across geographies, development status and sex. The most stark variations are regional in nature: the steepest falls were seen in rich countries like in Europe and the Americas. However, tobacco usage in developing countries in Asia and Africa has barely decreased, if not the same.

A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo and Azerbaijan for men and Kuwait and Timor-Leste for women).

The Lancet report singled out India, along with Pakistan and Panama, as three prime examples of countries that have implemented a large number of tobacco control policies over the past decade and have had marked declines in the prevalence of daily smoking since 2005, compared with decreases recorded between 1990 and 2005.

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The entire Lancet report can be read here.

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The tobacco epidemic

The scientific evidence that tobacco kills was made public in the 1960s and has since become one of the most publicised truths of modern times. But tobacco continues to kill and despite a steady decrease in tobacco usage in recent years, a lot of work remains to be done.

Smoking is the single largest preventable cause of death in the world. Every year, six million people are killed by tobacco. 600,000 of these deaths occur among non-smokers due to the effects of second-hand smoking.

Smoking was the second-leading risk factor for early death and disability worldwide in 2015. It has claimed more than 5 million lives every year since 1990 and its contribution to overall disease burden is growing, especially in lower income countries. The negative effects of smoking extend well beyond individual and population health as billions of dollars lost in productivity and health-care expenditure are related to smoking every year.

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The world’s war against tobacco

Successfully combating the tobacco industry’s pursuit of new smokers has been further complicated by the substantive—and sometimes rapid—social, demographic, and economic shifts occurring worldwide. As the tobacco industry moves to target previously untapped markets, strong tobacco control policies and timely monitoring of smoking patterns are imperative.

Since the 1990s, there has been a steep increase in tobacco control initiatives alongside mainstream awareness about the evils of tobacco usage in all forms. Some of these successful strategies and interventions include

• taxation of tobacco products,
• bans on smoking in public places,
• instituting smoke-free zones,
• restrictions on the marketing and promotion of cigarettes – including plain packaging laws,
• community-wide and nation-wide smoking cessation interventions,
• enforcement of both text and pictorial warning labels on tobacco products.
  

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Tobacco and the WHO: How FCTC made history

On an international, legislative scale, the most celebrated anti-tobacco policy has been the WHO Framework Convention on Tobacco Control (FCTC), which was adopted in Geneva, Switzerland in 2003

The FCTC is a supranational agreement that seeks “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke” by enacting a set of universal standards stating the dangers of tobacco and limiting its use in all forms worldwide.

To this end, the treaty’s provisions include rules that govern the production, sale, distribution, advertisement, and taxation of tobacco.

The FCTC is the world’s first public health treaty and has been a key driver of recent progress in reducing tobacco consumption and smoking prevalence in many regions of the world.

Ratified by 180 countries, the FCTC signified a watershed moment in global public health. Besides being one of the most quickly ratified treaties in United Nations history and one of the most consequential, the FCTC is also the first multilateral treaty regarding a chronic, non-communicable disease.

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FCTC standards are minimum requirements and signatories are encouraged to be even more stringent in regulating tobacco than the treaty requires them to be. Moreover, and as a reflection of how impactful this treaty has been on the world stage, several countries have committed to an even stronger anti-smoking goal, setting national targets to become tobacco-free. Additionally, strengthening FCTC implementation was explicitly included in the United Nations’ Sustainable Development Goals (SDGs).

The Lancet report, which indicates drop of tobacco usage around the world, is a vindication of the success of the FCTC and a testimony to the effectiveness of international cooperation. The success of the FCTC has fueled calls for similar global health treaties to suppress and eliminate other diseases, both communicable and noncommunicable.

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India’s war against tobacco

According to the World Health Organization (WHO), India is home to roughly 12% of the world’s smokers, or 120 million people. Tobacco claims the lives of 900,000 Indians annually.

According to the National Sample Survey, there are 184 million tobacco consumers in India, out of which 40% people chew various products that contain tobacco and 60% people smoke either cigarettes or beedis. Shockingly, about 20 million users belong to the age group of 10 – 14 years and about 5,500 new users are added to this figure every day.

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Legislation against tobacco in India dates back to 1975, when statutory health warnings were mandated on cigarette packs. Pictorial warnings against smoking on cigarette packets came into effect in 2009, requiring at least 40% of the cigarette package to display warnings about the health consequences of consuming tobacco. This was recently increased to 85%.

Smoking in public places was banned across the country from Gandhi Jayanti, 2008.

Tobacco smokers have steadily decreased in the last few years but the number of female smokers has almost doubled in the past three decades. Tobacco companies generate over Rs 29,000 crore annually and, according to The Tobacco Institute of India (TII), tobacco provides livelihood to 45.7 million Indians.

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The Logical Indian take

A massive portion of the Indian population either chews tobacco or smokes cigarettes and beedis. Most people, when confronted with the truth about the toxicity of their consumption, have a ready list of numerous excuses as to why they smoke or chew tobacco or some simply say that it has become a habit and they find difficult to get rid of despite knowing the consequences.

When a person smokes, they not only harms himself but also the people around him because inhaling the smoke is said to be more toxic than consuming it. Tobacco is the reason for 40% of all cancer cases in India and almost three out of five deaths in India are due to tobacco consumption.

As the Lancet study highlighted, the most efficient way to curb smoking is by implementing progressive legislation.

For this, governments have to consider five measures:

• taxation to raise cigarette prices,
• smoke-free places,
• cessation programmes,
• warning labels on cigarette packs, and
• bans on tobacco advertising.

These measures have been proven to work in all the countries where tobacco usage has witnessed a drastic decrease. Countries that introduced the aforementioned policies have seen their citizenry grow healthier and the tobacco industry diminish in power. There has been a global decrease in tobacco usage. Now, we must do more that sustain this decrease rate – we must escalate this decrease rate. For this to happen, governments need to adopt more stringent anti-tobacco policies. Countries need to understand that if they don’t kill the poison before it kills them, they have only themselves to blame.